Quality assuring an outsourced ambulatory electrocardiogram pathway

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The rising demand for arrhythmia care has led to the use of outsourced ambulatory electrocardiogram (ECG) pathways to maintain timely service delivery and meet diagnostic targets. Since COVID-19, our ambulatory ECG service operates primarily through external third-party providers, using the remote (postal) model, where monitors are dispatched to patients for self-application. This pathway was activated to comply with social distancing restrictions and has now been integrated into our diagnostic model of care. A quality assurance (QA) process was introduced to ensure compliance with our internal ECG reporting practice and escalation protocols. Purpose To quality assure our outsourced ambulatory ECG reports and pathways against internal practices and protocols. Methods We audited our QA records on outsourced services from 1st January 2022 - 31st December 2022. During this period, a total of 4317 patients were provided with an ambulatory ECG monitor via the remote service. We conducted regular (~every 2-3 months) retrospective random sampling of ambulatory ECG reports (~10%) for inclusion in QA. Our QA framework consists of a series of quality and consistency checks related to clinical information, report content, and adherence to escalation protocols (table 1). QA reports are fed back to our providers at quarterly meetings to ensure improved service quality. To obtain the requisite data, a variety of sources were cross-referenced. These included our QA reports, outsourced databases, third-party provider platforms, and our patient information system. Results Over a 12-month period, a total of 459 reports were quality assured. Ambulatory ECG reports were checked for clinical information, report content, supporting ECG evidence and amendment requests (table 1). A compliance rate of 99% was achieved. There were few cases (1%) where a request was made to the provider to amend the report or include additional information, namely ECG strips to clarify the findings. We also quality checked compliance to our escalation protocols: appropriate RAG (red, amber, green) rating and action, timely notification to clinicians, and adequate documentation. The reviewed ambulatory ECG reports were RAG rated as: Red 23 (5%), Amber 189 (40%), Green-Amber 142 (30%), Green 117 (25%). These were carried out with 99% accuracy. Activation of the appropriate escalation protocols and timely clinician notification achieved 100% compliance, including 23 red-flagged reports requiring immediate action. Conclusion The outsourced ambulatory ECG pathway had a very high rate of compliance with internal ECG reporting practice and escalation protocols. Our QA framework ensures we work in collaboration with our external partners to continually provide high-quality ECG diagnostics. We believe undertaking internal quality checks is a vital part of using outsourced service providers.